Revolutionary Doctors

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Revolutionary Doctors
How Venezuela and Cuba Are Changing the World’s
Conception of Health Care

by STEVE BROUWER

MONTHLY REVIEW PRESS
New York

Copyright © 2011 by Steve Brouwer
All rights reserved

Library of Congress Cataloging-in-Publication Data
Brouwer, Steve, 1947–
Revolutionary doctors : how Venezuela and Cuba are changing the world's
conception of health care / by Steve Brouwer.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-58367-239-6 (pbk. : alk. paper) — ISBN 978-1-58367-240-2
(cloth : alk. paper) 1. Community health services—Venezuela. 2.
Community health services—Cuba. 3. Medical education—Venezuela.
4. Medical education—Cuba. I. Title.
[DNLM: 1. Community Health Services—Cuba. 2. Community Health
Services—Venezuela. 3. Education, Medical—methods—Cuba. 4. Education,
Medical—methods—Venezuela. 5. Health Services Accessibility—Cuba. 6.
Health Services Accessibility—Venezuela. 7. International
Cooperation—Cuba. 8. International Cooperation—Venezuela. 9.
Physicians—Cuba. 10. Physicians—Venezuela. 11. Poverty—Cuba. 12.
Poverty—Venezuela. WA 546 DV4]
RA481.B76 2011
362.109-7291—dc23
2011016108

Monthly Review Press
146 West 29th Street, Suite 6W
New York, NY 10001

5 4 3 2 1

Contents

Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

1. Where Do Revolutionary Doctors Come From? . . . . . . . . . . . . 11
2. Solidarity and Internationalism . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
3. Creating Two, Three . . . One Hundred Thousand
Che Guevaras . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
4. Medicine in Revolutionary Cuba. . . . . . . . . . . . . . . . . . . . . . . . . . 55
5. Barrio Adentro . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
6. Witnessing Barrio Adentro in Action . . . . . . . . . . . . . . . . . . . . . . 95
7. New Doctors for Venezuela . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
8. Building Community Medicine on a Daily Basis . . . . . . . . . . 129
9. Revolutionary Medicine in Conflict with the Past . . . . . . . . . 153
10. The Battle of Ideas and the Battle for Our America . . . . . . . . 175
11. The War on Ideas: The U.S.
Counterinsurgency Campaign . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
12. Practicing Medicine, Practicing Revolution . . . . . . . . . . . . . . . 215

Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247

Acknowledgments

I did not go to Venezuela in September of 2007 to write a book about
the revolutionary practice of medicine. I went to live in a mountain vil-
lage and write about how rural people, especially the campesinos in
and around Monte Carmelo, were transforming their lives through
their active participation in the Bolivarian Revolution. Although I nar-
rowed my focus to tell about one important part of this revolutionary
process and its connection to the Cuban Revolution, I learned an
immense amount about rural life from my campesino neighbors in
Monte Carmelo, who provided support, kindness, and friendship to
me and my sons during our nine-month stay. This small village is
gaining renown throughout Venezuela for its cooperative spirit, soli-
darity, experimental agriculture, and grassroots organizing ability, and
so it really merits a book of its own. (I hope to write more about Monte
Carmelo. In the meantime, readers can still find blog articles I wrote
in 2007–08 at www.venezuelanotes.blogspot.com.)
Though I cannot possibly list the names of everyone who ought to
be thanked, I want to give special thanks to the family of Gaudy and
Omar Garcia and the family of Abigail and Gabriel Garcia, and other
members of their extended families: Sandino, Luz Marina, Polilla,
Carmen Alicia, Hector, Alexis, Arturo, Cesar, Javier, and Maira. They

8 REVOLUTIONARY DOCTORS

not only provided us with hospitality, close friendship, and a place to
live but were invaluable in sharing an intimate knowledge of village
life, farming, and the beautiful natural world that surrounds them.
I am especially indebted to the medical students and doctors in the
Monte Carmelo and Sanare area who allowed me to spend time in
their clinics and classrooms, as well as learn about their lives and aspi-
rations. I refer to them only by their first names since I do not have
everyone’s last name accurately recorded. The Venezuelan medical
students: Mariela, Milena, Édison, Jonás, Arelys, Iris, Yeiny, Inez,
Odalys, Luisa, Antonio, Magaly, Vanesa, Dilbex, José, Hilario, Rosana,
Mileidy, Vanesa, Karina, Juan, and José Antonio; the students from
Suriname: Georgo, Isabel, and Meredith. Doctors working at the
Barrio Adentro walk-in clinics and the Diagnostic Center: Dr.
Tomasa, Dr. Barbara, Dr. Edita, Dr. Raúl, the two Dr. Franks, Dr.
Alina, and Dr. Humberto.
Many thanks to two North American friends, Lisa Sullivan and
Charlie Hardy, who have lived for decades in Venezuela, spending
most of that time living and working among the poor in the barrios of
Caracas and Barquisimeto. They were indispensable for introductions
to many Venezuelans who became friends and contacts, and invalu-
able in their help on various trips I made to Venezuela. Five friends
from the nearby town of Sanare, all of them teachers—Honorio,
Irlanda, Rubén, Goya, and Luis—were particularly helpful in
acquainting me with local progressive and revolutionary traditions in
education, politics, religion, and society that predate the Chávez gov-
ernment institutions. The two Morochos, the unofficial village anthro-
pologists and poets of Monte Carmelo, were very generous in filling
me in on local history and folklore. My first guides to Caracas, Marcela
and Antonio, gave me an exceptional introduction to the barrios and
the rest of the city. Other valued friends who helped in Venezuela
include Mario, Rosa Elena, Pablo, Ledys, David, Pachi, Maia, Joséito,
and Father Mario Grippo.
In Cuba, my good friends the poet Victor Casaus and journalist
Hedelberto Lopez Blanch were extremely helpful in Havana. Gail
Reed and Conner Gorry, journalists based in Havana working for

ACKNOWLEDGMENTS 9

MEDICC Review, provided me with invaluable advice and informa-
tion. MEDICC Review, featuring articles by Cuban and U.S. medical
experts, is the only peer-reviewed journal in English dedicated to
Cuban medicine. This magazine and website, a joint venture by
Cuban and U.S. medical experts, is a great resource and extremely
reliable. I want to thank philosopher and journalist Enrique Ubieta
Gómez for sharing his time with me and thoughts related to his excel-
lent book, Venezuela rebelde: dinero vs. solidaridad. At ELAM, the
Latin American School of Medicine in Havana, Dr. Midalys Castilla
Martínez, the vice rector, was generous with her time as she intro-
duced me to the school and some of the students.
At Monthly Review Press, I would like to thank Fred Magdoff,
who visited us briefly in Venezuela and suggested the press could be
interested in a book on revolutionary medicine. Michael Yates has
been an excellent editor, displaying great patience and sound judg-
ment, and Erin Clermont served as a great copyeditor with a sharp eye
for clarity.
My two sons, Jan and Ari, who were eighteen and sixteen at the
time, lived with me in Monte Carmelo and provided wonderful com-
panionship and good humor. They also ended up working full-time
with our campesino neighbors at the Las Lajitas cooperative organic
farm—they began their half-hour climb up the mountain at 5:30 every
morning and spent their days digging, planting, harvesting, and com-
posting with worms; they even learned how to plow with a horse on
the steep mountainsides. In the afternoons they came home with an
extraordinary variety of vegetables and the world’s tastiest yogurt.
And many thanks, as always, to my wife, Susan, who could only visit
us for a few weeks because she had to stay at home in Pennsylvania
teaching her classes while providing lots of encouragement, love, and
our material support.
Finally I want to dedicate this book to the memory of my father,
Dr. Stephen W. Brouwer, a physician renowned for his good humor
and willingness to listen to patients. One of the few things that could
anger him was the death of someone who sought treatment too late
because of worries about the cost. He blamed such deaths on a health


system that would not countenance free and universal care. My father
was the only doctor I knew in my youth who was a socialist—in fact,
he was the only socialist I knew—so he would surely be glad to know
that today revolutionary doctors are transforming health care in the
poorest and most remote parts of the Americas.

1. Where Do Revolutionary
Doctors Come From?
The campesinos would have run, immediately and with unreserved
enthusiasm, to help their brothers.
—CHE GUEVARA , “On Revolutionary Medicine,” 1960

Even though he came to Cuba with a rifle slung over his shoulder and
entered Havana in 1959 as one of the victorious commanders of the
Cuban Revolution, he still continued to think of himself as a doctor.
Five years earlier, the twenty-five-year-old Argentine had arrived in
Guatemala and offered to put his newly earned medical degree at the
service of a peaceful social transformation. Dr. Ernesto Guevara was
hoping to find work in the public health services and contribute to the
wide-ranging reforms being initiated by President Arbenz, but he
never had much opportunity to work as a physician in Guatemala.
Within months of his arrival, Arbenz’s government was brought down
by the military coup d’état devised by the United Fruit Company,
some Guatemalan colonels, the U.S. State Department, and the CIA.
Che never lost sight of the value of his original aspiration—com-
bining the humanitarian mission of medicine with the creation of a just
society. When he addressed the Cuban militia on August 19, 1960, a


year and a half after the triumph of the revolution, he chose to speak
about “Revolutionary Medicine” and the possibility of educating a
new kind of doctor.

A few months ago, here in Havana, it happened that a group of newly
graduated doctors did not want to go into the country’s rural areas
and demanded remuneration before they would agree to go. . . .
But what would have happened if instead of these boys, whose
families generally were able to pay for their years of study, others of
less fortunate means had just finished their schooling and were begin-
ning the exercise of their profession? What would have occurred if
two or three hundred campesinos had emerged, let us say by magic,
from the university halls?
What would have happened, simply, is that the campesinos would
have run, immediately and with unreserved enthusiasm, to help their
brothers.

Since then, Cuban medicine and health services have been devel-
oped in a number of unique and revolutionary ways, but only now,
nearly fifty years later, has Che’s dream come to full fruition. Today it is
literally true that campesinos, along with the children of impoverished
working-class and indigenous communities, are becoming doctors and
running, “with unreserved enthusiasm, to help their brothers.”
While this is happening on the mountainsides of Haiti, among the
Garifuna people on the Caribbean coast of Honduras, in the villages
of Africa and the highlands of Bolivia, it is occurring on the grandest
scale in the rural towns and city barrios of Venezuela. When I was
living in the mountains of western Venezuela in 2007 and 2008, I wit-
nessed the emergence of revolutionary doctors every morning as I
walked out the door of our little tin-roofed house. The scene would
have delighted Che:

As the sun rises above the mountain behind the village of Monte
Carmelo and the white mist begins to lift off the cloud forest, four
young campesinos walk along the road in their wine-red polo shirts

WHERE DO REVOLUTIONARY DOCTORS COME FROM? 13

with their crisp, white jackets folded up under their arms to protect
them from the dust. At 7 a.m. they wave goodbye to the high school
students who are waiting to begin their classes in three rooms at the
women’s cooperative and then hop aboard the “taxi,” a tough, thirty-
year-old Toyota pickup truck that often packs twenty or more people
in the back. They travel down the winding mountain road, through
the deep ravine at the bottom, and up the hill on the far side of the
valley to the larger town of Sanare, where they are going to work all
morning alongside Cuban doctors in neighborhood consulting
offices and the modern Diagnostic Clinic.
Around 7:45, four more medical students from the village, already
donning their white jackets, walk by our house, past the plaza and the
little church, and gather in front of a small concrete block building
called the ambulatorio. About the same time, they are joined by three
more medical students who emerge from Carlos’s bright blue jeep,
“the Navigator,” one of the other vehicles in the taxi cooperative that
serves the village. These students from Sanare pull on their white
jackets, hug their compañeros, and wait for Elsy, a health committee
volunteer who is studying to be a nurse, to unlock the gate to the
ambulatorio, the walk-in clinic that offers Barrio Adentro medical
service.
As I stroll by, I see the prospective patients sitting on the benches
of the small, covered patio in front of the entrance door. They are
waiting for Dr. Tomasa, the family medical specialist. Two chirpy
teenage girls sit next to Dr. Raul’s dentistry room and grin with per-
fect-looking smiles. “What could be wrong with your teeth?” I ask.
“Nothing,” responds one of them, “Dr. Raul is giving us another
checkup.” Another checkup? Their parents never had a single
checkup when they were young—consequently, there are many
people over forty or fifty who have very few teeth.
By 8 a.m. one of the medical students stands behind the simple
wooden counter, performing receptionist duties. Another shuttles
back and forth to the file shelves, organizing and updating medical
information that is kept on every family in the community. A third
chats informally with the waiting patients, entertaining their small


children, and informally inquiring about their families’ health. The
other four students stand alongside Dr. Tomasa in the consulting
office, watching her take family and individual histories and give
examinations. They also fetch medicines, take temperatures, and
weigh healthy children who are accompanying their mothers.
Today, like every day, Dr. Tomasa says to her students, “Por favor,
more questions. This is how we learn. You can never ask too many
questions.”

Monte Carmelo is a small village that stretches along a single paved
road on a mountain ridge in the foothills of the Andes in the state of
Lara. Before Hugo Chávez assumed the presidency of Venezuela in
1999, the road was unpaved and the high school did not exist.
According to the 2007 census, its population consisted of 129 fami-
lies and approximately 700 individuals, nearly all of them supporting
themselves by working small parcels of land by hand, or with horses
and oxen. That same year nine residents of Monte Carmelo were med-
ical students. Eight were studying Medicina Integral Comunitaria
(popularly known as MIC), an intensive six-year course that in
English is usually called Comprehensive Community Medicine. A
ninth village resident was studying medicine in Cuba. Two more
young women from a neighboring hamlet were also in medical school.
They were part of a group of sixty-seven students in this agricultural
region who were becoming doctors of medicine.
The students are a diverse lot: some are nineteen or twenty years
old and have recently finished high school; others are closer to thirty
and have young children; a few are even older. Some young mothers
have recently completed their secondary education through Mission
Ribas, one of the Bolivarian social missions that bring adults back to
school on evenings and weekends. All of the students are enthusiastic
about their role in fostering good health and introducing reliable med-
ical care into the fabric of their community and the larger world. And
many of them dream of emulating their Cuban teachers and one day
serving as internationalist physicians themselves in remote and impov-
erished parts of the world.


This experiment in training new doctors in MIC would be
worthy of international attention even if the program was limited to
the 67 students in this remote coffee-growing region in the state of
Lara. But in fact they represent only a tiny fraction of a gigantic effort
to transform medical education and health care delivery throughout
all of Venezuela. Nearly 25,000 students were enrolled in the first
four years of MIC in 2007–2008, and by 2009 and 2010 they were
joined by more students, swelling the ranks of students enrolled in
all six years of MIC to approximately 30,000. This is almost as
many as the total number of doctors who were practicing medicine
in all capacities in Venezuela when Hugo Chávez was elected presi-
dent in 1998.
One unique aspect of MIC is that the students in Monte Carmelo
do not have to leave the campo, the countryside, nor do students in the
poorest neighborhoods of Venezuelan cities have to desert their bar-
rios in order to attend medical school. Medicina Integral Comunitaria
is a “university without walls” that trains young doctors in their home
environments. This is not a short-term course for health aides or
“barefoot doctors,” but a rigorous program designed to produce a
new kind of physician. Every morning during their years of study, the
MIC students help doctors working in Barrio Adentro attend to
patients’ illnesses and learn to comprehend the broad public health
needs of their communities. And every afternoon, they meet with their
MIC professors in a series of formal medical classes that constitute a
rigorous curriculum and include all the medical sciences studied at
traditional universities.
The MIC education program could not exist without Barrio
Adentro, the nationwide health system that first began delivering pri-
mary care in 2003 thanks to an enormous commitment of expertise
from Cuba. From 2004 to 2010, Barrio Adentro continually deployed
between 10,000 and 14,000 Cuban doctors and 15,000 to 20,000
other Cuban medical personnel—dentists, nurses, physical therapists,
optometrists, and technicians. Their services are available to all
Venezuelans for free at almost 7,000 walk-in offices and over 500
larger diagnostic clinics, and they have been very effective in meeting


the needs of 80 percent of the population that had been ill-served or
not served at all by the old health care system.
Obviously, Cuba cannot afford to devote so many of its medical
personnel to Venezuela indefinitely, nor does the Chávez government
want to depend on foreign doctors forever. So when Barrio Adentro
was being launched in 2003, Cuban and Venezuelan medical experts
devised a new program of medical education that will enable
Venezuela to keep its universal public health program functioning per-
manently. Starting in 2005, the Cuban doctors were asked to perform
a rigorous double duty: not only did they continue treating patients in
Barrio Adentro clinics, but many of them also began teaching as pro-
fessor/tutors for the MIC program in comprehensive community
medicine. The goal of MIC is to integrate the training of family prac-
titioners into the fabric of communities in a holistic effort that meets
the medical needs of all citizens, makes use of local resources, and pro-
motes preventive health care and healthy living.
The Cuban mission in Venezuela is possible because over the past
half-century, Cuba has developed a vision of medical service that goes
far beyond its own borders. Cuban health workers, in addition to pro-
viding free health care for all their fellow citizens, have transformed
themselves into a “weapon of solidarity,” a revolutionary force that has
been deployed in over 100 countries around the world. Since 2000,
however, the Cuban commitment has increased substantially because
the Bolivarian Revolution in Venezuela has contributed its own enthu-
siasm, volunteers, and economic resources. Through various agree-
ments of cooperation, Cuba and Venezuela have embarked upon a
number of projects in other fields such as education, agriculture, energy,
and industrial development, and then have extended these cooperative
ventures to other nations, particularly within ALBA, the Bolivarian
Alliance for the Peoples of Our America, which includes Bolivia,
Nicaragua, and Ecuador as well as the small Caribbean island nations of
Dominica, Antigua and Barbuda, Saint Vincent and the Grenadines.
Of all these ambitious undertakings, delivering medical services is
by far the most prominent. In order to extend universal health care to
the poor and working classes in way that is compatible with the new,


egalitarian vision of these societies, many more physicians are needed.
With this in mind, Cuba is educating more doctors at home even as it
trains tens of thousands in Venezuela. In 2008 there were 29,000
Cubans enrolled in medical school, plus nearly 24,000 foreign stu-
dents (including more than one hundred students from the United
States) studying at the Latin American School of Medicine in Havana
or at the schools of the New Program for the Training of Latin
American Doctors that are located in four other provinces.

An Army in White Jackets

I first became aware of the magnitude of this medical revolution in
2004 on my first trip to Venezuela. When Dr. Yonel, a young Cuban
dentist working in a barrio of Caracas, informed me there were more
than 10,000 doctors working in Venezuela, I exclaimed, “Un ejército
de medicos! An army of doctors!”
Dr. Yonel smiled and replied, “Un ejército de paz. An army of
peace.”
Clearly the collaboration of the rejuvenated Cuban Revolution and
the nascent Bolivarian Revolution was yielding impressive results.
And a growing number of countries in the Western Hemisphere, long
under the yoke of wealthy conservative minorities or military authori-
tarians who were dependent on capital and political instruction from
the North, were no longer willing to listen to the United States when
it told them to shun Cuba and Venezuela. Since its long-standing eco-
nomic blockade of Cuba was failing to deter these developments, the
United States tried to launch a disruptive dissident movement in Cuba
and assist a coup d’état in Venezuela. When these efforts failed, the
U.S. government imposed more draconian economic and travel
restrictions on Cuba in 2004 and funded various schemes to under-
mine both revolutionary governments. In 2006, the United States
stooped to an especially low level when it attempted to directly sabo-
tage Cuba’s humanitarian medical missions by creating the Cuban
Medical Professional Parole Program. This was a law specifically


designed to lure Cuban doctors, nurses, and technicians away from
their foreign assignments by offering them special immigration status
and speedy entry into the United States.
These antagonistic efforts did not succeed in diminishing the
international solidarity and prestige that Cuba and Venezuela were
acquiring around the world, nor did it keep them from expanding
their programs of humanitarian medical aid and international medical
education. In 2007, a young Chilean, a member of the third class
graduating from the Latin American School of Medicine in Havana,
spoke at her commencement and told her classmates: “Today we are
an army in white jackets that will bring good health and a little more
dignity to our people.”1
By 2010, Cuba and Venezuela further demonstrated their capabil-
ities by being among the most prominent providers of both emergency
and long-term aid to Haiti after its devastating earthquake. Brazil, the
economic giant of Latin America, signaled its admiration by
announcing that it would be delighted to join Cuba in a partnership to
create a new public health system in Haiti. José Gomés, the Brazilian
Minister of Health, explained why his country was choosing to work
with the Cubans on such a significant and demanding project: “We
have just signed an agreement—Cuba, Brazil, and Haiti—according to
which all three countries make a commitment to unite our forces in
order to reconstruct the health system in Haiti. . . . We will provide
this, together with Cuba—a country with an extremely long interna-
tionalist experience, a great degree of technical ability, great determi-
nation, and an enormous amount of heart.”2
For Cuba, Venezuela, and by extension their allies in ALBA alliance,
these triumphs throughout the first decade of the twenty-first century
were more than diplomatic coups, they were moral victories. They
demonstrated the power of social solidarity and humanistic concern for
other people, values in stark contrast with the materialistic, self-cen-
tered, and aggressive behavior of the advanced capitalist societies.
This book aims to acquaint the reader with the ways that revolu-
tionary doctors and health care workers have developed into major
protagonists of socialist change and are defining what that change


should look like. Chapters 2 through 4 offer some glimpses of Cuba’s
international medical missions, their profound impact on various
parts of the world, and their relation to the overall development of
Cuban health care over the past fifty years. Chapters 5 through 8
describe how a new public health system, Barrio Adentro, has been
created in Venezuela, and how new Venezuelan doctors are being edu-
cated to assume responsibility for this system in the future. This
description is based on my own observations of day-to-day interac-
tions of doctors, medical students, health committees, and the mem-
bers of the communities they serve. Finally, the last four chapters
illustrate how capitalist cultures and imperialist forces are resisting the
development of revolutionary medicine and revolutionary conscious-
ness, while the emerging socialist cultures are pressing forward with
new ideas and creating the patterns of practice and commitment in
daily life that are producing the revolutionaries of the future.

2. Solidarity and Internationalism
I began to travel throughout America . . . First as a student and later
as a doctor, I came into close contact with poverty, hunger, and dis-
ease; with the inability to treat a child because of lack of money; with
the stupefaction provoked by continual hunger and punishment, to
the point that a father can accept the loss of a son as an unimportant
accident, as occurs often in the downtrodden classes of our
American homeland. And I began to realize at that time that there
were things that were almost as important to me as becoming famous
or making a significant contribution to medical science: I wanted to
help those people.
—CHE GUEVARA , “On Revolutionary Medicine,” 1960 speech

Che’s travels through the American hemisphere in the early 1950s
were his first steps toward developing a revolutionary international
consciousness. Over the next few years his desire to help the poor and
the oppressed was transformed into a decision to stand in solidarity
with them, and to join in their struggles to assert their dignity and
humanity. When he arrived in Guatemala hoping to put his medical
skills at the service of the people, there were no Latin American net-
works that promoted internationalism and solidarity on the part of


young health professionals who wanted to work and live among the
poorest people in the hemisphere.
Today there is such a place, founded in 1998, which bears this
inscription on the walls of its reception hall:

ESTA SERÁ UNA BATALLA DE LA SOLIDARIDAD CONTRA EL EGOÍSMO.
(This will be a battle of solidarity against selfishness.)

The quotation from Fidel can be found inside the Latin American
School of Medicine outside Havana (in Spanish the school is called La
Escuela Latinoamericana de Medicina, usually referred to by its
acronym, ELAM). Fidel’s words are written in oversized script above
a large map of the world that indicates all the places where Cuban
medical brigades have completed humanitarian missions through a
program of international medical cooperation known as Plan Integral
de Salud (the Comprehensive Health Plan). The school, like the
inscription, is a testimony to Che’s vision and to the example set by
the Cuban health care professionals. By embracing the solidarity of
international cooperation and offering free medical attention to
everyone, they represent the ideal of service for the foreign students
who come to ELAM.
On other large maps in the entry hall at the medical school, there
are lists of the exact number of students in attendance from twenty dif-
ferent countries. The large majority are the first in their families to
attend any kind of university and come from poor communities that
do not have adequate medical facilities. The students’ obligation, in
return for the free education they are receiving, is to return home in
solidarity with the poor of their native country and dedicate them-
selves to practicing community health care and preventive medicine.
In March 2009, when I visited ELAM in Havana (there is also
another much smaller ELAM campus in Santiago de Cuba, with stu-
dents from five countries, including Haiti), there were 1,576 first-year
students at the campus and another 1,287 in the second year of the
six-year program. The rest of the 5,310 ELAM students, in their third
through sixth years of studies, were continuing their training at other

S O L I D A R I T Y A N D I N T E R N AT I O N A L I S M 23

medical faculties located in all thirteen provinces of Cuba. The largest
number of first-year students, 144, came from Mexico; next were 108
from Bolivia; way down the list, second to last in number, 27 from
Belize; and finally, 23 students from the United States.

U.S. Students at the Latin American School of Medicine

Four of the U.S. students chatted with me when they had some free
time between classes. One, Pasha Jackson, had an unusual personal
history for an ELAM student, for he did not, like most students, come
directly to Cuba from a poor family in an impoverished part of the
hemisphere. He had come from the world of professional football.
Pasha had played at the University of Oklahoma, then in the National
Football League with the San Francisco 49ers, the Indianapolis Colts,
and the Oakland Raiders. Nagged by a recurring shoulder injury
during his four-year pro career, he finally decided to retire from the
game. “It wasn’t so difficult,” he said, “because I had dreamt about
two things all my life, being a football player and being a doctor. Now
I could proceed with becoming a doctor.”
Why did he come to Cuba? “I was looking for a revolutionary path
in medicine, a way of becoming a physician and a revolutionary who
can serve the people in the most helpful way possible. Medical school
in the States didn’t offer me that possibility. They are producing a dif-
ferent kind of M.D. It was my father who heard about studying med-
icine in Cuba and urged me to apply.”
Frances, whose family comes from Nigeria, grew up in the South
Bronx in New York City. She had finished her undergraduate studies
and a year of postgraduate predoctoral courses in preparation for med-
ical school, when she heard about the possibility of studying in Cuba
from the pastor at her church. She said she had previously thought of
applying to U.S. schools—“the University of Pennsylvania had an inte-
grated curriculum that I particularly liked”—but they were prohibi-
tively expensive. In 2009, she and Pasha were completing their premed
year, an important preparatory course of study that gets all students on


the same page and includes intensive language courses for non-
Spanish-speaking students. In order to immerse herself more fully in
the language, Francis had chosen to move out of her original dormitory
area, which housed English-speaking students from the United States
and Belize, and reside with all-Spanish-speaking students.
Ian Fabian, a Dominican American who also came from New York
City, was in his first year of regular medical studies at ELAM in 2009.
When he finished his undergraduate work and was working at a uni-
versity neuroscience laboratory in New York, he too began thinking
about applying to medical schools. The cost seemed very high to him,
especially when he took note of the kinds of medical students who
came through his laboratory. “Those students are super-competitive
and individualistic. It’s a cutthroat atmosphere, with no signs of a
cooperative spirit and working together. I wanted something very dif-
ferent, an atmosphere of contributing together, helping each other
along, working toward a common goal of serving society. When I
heard about the possibility of studying here, I knew it was for me.”
Malik Sharif, another first-year student, was also working at a lab-
oratory, in his hometown of Cleveland, but like the others was dis-
couraged about the cost of attending medical school and the over-
whelming burden of taking out loans that could easily add up to
$150,000 or $200,000. One day a medical school professor from
Berkeley visited his lab, spoke highly of the quality of education avail-
able at ELAM, and suggested that Malik consider studying in Cuba.
By working through the Interfaith Interreligious Foundation for
Community Organizing founded by Reverend Lucius Walker of New
York, Malik found that he could file an online application to ELAM
in a very efficient and straightforward manner. Once in Cuba, Malik
said, he and his fellow Americans were pleased to find it was not dif-
ficult to make adjustments to living in a different society. “And you
know, it may seem like a small thing, but I was afraid I wouldn’t like
the food. The cafeteria people have looked after us very well.” He
was referring not only to the quality of the food, but to the fact that he
and Pasha try to follow a Muslim diet. The cafeterias at ELAM cater
to those who have special food needs, either for health or religious


reasons. This way the two young men could avoid eating pork, one of
the favorite meats of Cubans.
These four students were looking forward to practicing family
medicine within a community setting, and wanted to find a way to
integrate that practice into a social network of preventive care and pro-
moting good health when they return to the United States. They
know that family and community practice is not as well compensated
as other specialties in U.S. medicine, but they said the lower pay ought
to be sufficient for their needs, especially since they will not have huge
loans to pay off like so many of their American counterparts.
Dr. Midalys Castilla Martínez, the vice rector in charge of instruc-
tion at ELAM, explained that there is no ideological test for incoming
students, who are of various political persuasions and religious back-
grounds; the latter are helped to find places where they can practice
their religion while they are in Cuba.
Over time ELAM has devised ways to make this wide array of for-
eign students comfortable during their time in Cuba, and conse-
quently the student retention rate in 2009 was 85 percent or more,
about 10 percent higher than it used to be. The first year is the most
difficult, and once students have managed to get into second year and
beyond the retention rate is above 90 percent. The school realizes
that all students are going to be separated from their own cultures for
a very long time, so it provides various kinds of support. Dr. Castilla
said that counselors and psychologists are available to talk with stu-
dents about personal and social problems that arise. Furthermore,
students are assigned guias or guides, faculty mentor/advisors who
talk with them often and are aware of their academic progress and
their personal demeanor, so that they will notice if a student is
depressed, frustrated, or falling behind. Special tutoring is always
available, so that any who are anxious about their progress or compre-
hension can get immediate help.
When it comes to the student’s commitment to returning home
to work with the neglected and excluded communities, Dr. Castilla
acknowledged that there was no way for Cuba to enforce such a pro-
vision. However, ELAM has tried to work with progressive groups


and government ministries in other countries to facilitate internships
and entrée into public service. For a number of countries, such as
Guatemala and Haiti, Cuba and ELAM have made agreements to
establish formal residencies in comprehensive community medicine
for graduates. Young Guatemalan and Haitian doctors return home
and go to work in clinics in the remote rural areas where Cuban doc-
tors have been working for more than a decade, preparing to assume
this responsibility in the future. These residency programs, like
ELAM itself, are a direct outgrowth of the Comprehensive Health
Plan of 1998. In the United States, there is no public support for
students returning from ELAM; in fact, the Bush administration
would have barred all students from attending medical school in
Cuba in 2004 if not for the intervention of Secretary of State Colin
Powell, who argued that the U.S. government would face criticism
for keeping a number of minority students from receiving a free med-
ical education.

The Birth of Plan Integral de Salud

The campus of ELAM was once the Cuban Naval Academy, a place
where both navy military recruits and merchant marine sailors were
trained in the past. Its solid white buildings, trimmed in blue, sit in a
picturesque location on the edge of the sea on the north coast of Cuba
west of Havana. In 1998, according to Dr. Castilla, General Raúl
Castro, then in charge of the Cuban armed forces, was overseeing the
decommissioning of various military facilities throughout Cuba
because the nation was committed to substantially reducing its mili-
tary budget. He suggested to his brother, President Fidel Castro, that
the Cuban naval academy would be an ideal location for a new med-
ical school that would serve foreign students from Latin America. The
conversion was approved in November of 1998, and the first students
were able to enroll and attend classes in the latter part of 1999.
The sudden transformation of the Naval Academy into a medical
school followed immediately upon the creation of the Plan Integral de


Salud, or Comprehensive Health Plan, that was Cuba’s response to
two devastating hurricanes, George and Mitch, that swept through the
Caribbean and Central America in 1998. George struck Haiti and the
Dominican Republic in the summer, and Mitch caused devastating
floods and killed 30,000 people in Nicaragua, Belize, Guatemala, and
Honduras in October 1998. Many of the areas most damaged by
these disasters were remote places where people had little or no access
to health services of any kind. Cuba immediately sent 2,000 doctors
and other medical personnel to give emergency care for victims of the
disasters, but they also offered another kind of commitment that
proved even more valuable.
The Plan Integral de Salud is an agreement that promises free
Cuban medical assistance over the long term to help rectify the defi-
ciencies of local health systems. There are three main conditions in
the agreement between Cuba and the host country:

1. The host country accepts Cuban medical collaborators, including
doctors in comprehensive general medicine (medicina general inte-
gral), nurses, and other professionals, who stay for two-year
periods and then are replaced by a new volunteers;

2. Cuban health care personnel not only provide primary health
care to the local population but also start developing local human
resources that will be able to promote good health care in the
future. This includes onsite training of health assistants and
grassroots educators in preventive medicine, as well as enroll-
ment of young people at ELAM for a six-year medical education
as physicians;

3. Cuban medical teams avoid interfering with the medical practices
of local doctors; usually the teams are located in rural areas where
no one has ever provided health care.

Cuba has been faithful to these accords, which rapidly spread
beyond the Central American and Caribbean victims of the 1998 hur-


ricanes, so that ten years later the Plan Integral de Salud included
service to thirty-six different countries in Africa, Asia, Oceana, Latin
America, and the Caribbean. At the end of 2008, there were 3,462 col-
laborators, 2,393 of them doctors, working on these missions.
Because new medical personnel are rotated into these nations on a
regular basis, the cumulative total of Cubans involved is very high.
Approximately 67,000 health professionals worked in the Plan
Integral de Salud missions between 1998 and 2008, over 6,000 of
them in Haiti alone.
Because Cuba never planned on staying in the host nations forever,
the Latin American School of Medicine was conceived and put into
operation as soon as the first medical brigades were dispatched in
1998. In the first several years of ELAM’s existence, the largest num-
bers of students enrolling and graduating with medical degrees came
from three of the countries—Haiti, Guatemala, and Honduras—that
originally agreed to take part in the Plan Integral de Salud. Now that
ELAM has produced about 9,000 physicians who graduated in the
first six classes (2005 through 2010), each of these countries has sev-
eral hundred new doctors prepared to provide care to their under-
served populations.

Cuban Support for Haiti

The significance of the Cuban commitment to international soli-
darity in health care can be appreciated by looking at the medical sit-
uation in Haiti on January 12, 2010. At the moment the monstrous
earthquake shattered this nation, there were fewer than 2,000 Haitian
doctors for a population of nine million people. In many parts of the
country the only medical care available before the earthquake was
being delivered by 344 Cuban medical professionals who were
deployed on medical missions through the Plan Integral de Salud
(more than half were physicians, the others highly trained nurses and
medical technicians). They were working in public hospitals and
small public clinics alongside Haitian medical personnel, many of


whom had graduated from ELAM (547 Haitians obtained medical
degrees from ELAM between 2005 and 2009).1
The core group of Cuban-trained medical workers quickly mobi-
lized on the day after the earthquake, relocating as necessary to the
hardest-hit areas, including the capital of Port-au-Prince. With 400 of
the Haitian graduates from ELAM working with them, they proved to
be the largest, most reliable, and best organized source of emergency
treatment in the nation. Within a few weeks, 185 Haitian medical stu-
dents from Cuba were also able to join the group as interns, granted
leaves of absence from their fifth and sixth years of study at ELAM to
aid their suffering nation.
This added up to a coordinated medical presence of nearly a
thousand Cubans and Haitians who were familiar with Haiti’s cul-
ture and Creole, the language of the vast majority of local citizens.
Speaking both Creole and Spanish, this group was well equipped to
translate for the rapidly growing contingents of Cuban-educated and
Spanish-speaking doctors who kept arriving in Haiti. Over the
course of the spring and the summer, the number of doctors who
had been trained in Cuba kept expanding, so that by July they num-
bered over 1,500 and included ELAM graduates from Haiti and
twenty-six other countries.
Also among those who recently graduated from ELAM were those
who came in February to join the Henry Reeve Brigade. This was the
first time that ELAM graduates had been incorporated into this pres-
tigious group, which is composed of veteran Cuban medical experts
who regularly respond to natural disasters throughout the world. The
Henry Reeve Medical Brigade was named in honor of a nineteen-year-
old American who volunteered to fight for Cuban independence in
the Ten Years War of 1868–1878. Henry Reeve led cavalry troops
against the Spanish army in over 400 engagements and injured his leg
so badly that he had to be fitted with metal braces and strapped to his
horse in order to ride into battle. He ended up a brigadier general
under the command of the revolutionary hero General Máximo
Gómez, and died when his cavalry unit was surrounded by the
Spanish in 1876.


Since Henry Reeve was a young U.S. internationalist, it was only
fitting that the first ELAM arrivals were seven young women from the
United States. They were recent graduates of ELAM who had inter-
rupted preparations for their medical board examinations in the
United States in order to live and work among the Haitian people. For
them “it was no problem in sleeping in tents and working any hour of
the day or night.”2
The following week, another ELAM graduate, Marcela Vera from
Colombia, arrived with a larger group of Henry Reeve volunteers. A
month earlier she had tried unsuccessfully to join other relief efforts.
Médecins Sans Frontières turned her down because she did not
speak French, and the Red Cross told her she did not have the
required two years’ experience in disaster relief. When she heard that
ELAM was organizing a brigade of former students, she filled up her
backpack and headed to Cuba in less than forty-eight hours. Marcela
and the ELAM graduates were given an intensive crash course by
Havana’s experts in disaster relief medicine, then sent on to Haiti to
assist the experienced teams that by this time had set up more than
twenty field hospitals. Once there, Marcela took up residence in a
tent in a camp where the homeless were living and, like many of the
ELAM arrivals, was quickly put to work vaccinating everyone against
infectious diseases.3
In the immediate aftermath of the quake, there were a great many
other foreign volunteers arriving to work on short-term assignments
with various relief organizations that had no connection to Cuba.
Some of them found that no one knew where they should be assigned
to work, or they were sent to places where there were no supplies or
coordination of any kind. But others found they could be readily incor-
porated into Cuban-Haitian efforts. At La Paz Hospital, one of the few
medical facilities in the capital of Port-au-Prince that was not
destroyed, a Cuban team had taken charge of operations the day after
the earthquake. When doctors and nurses arrived from Spain, Chile,
Mexico, the Dominican Republic, Canada, and other nations, they
were rapidly integrated with Cuban and Haitian colleagues. Reporter
Leticia Martínez Hernández described one scene: “Rosalía, a nun, was


caressing a little girl whose leg was in danger due to gangrene. She
came from Spain. . . . For Asmyrrehe Dollin, a Haitian doctor who
graduated in Cuba, helping his compatriots is the greatest thing that life
has bestowed on him. . . . Working together with the doctors who at
one point were his professors, is an immense source of pride for him.”4
Dr. Mirta Roses, the Argentine director of the Pan American
Health Organization, praised the Cubans for their ability to coordi-
nate the efforts of specialists arriving from dozens of countries: “We
were already aware of their organizational capacity, their experience in
disaster management; and it has been an enormous advantage that
they were already here.” There were well-intentioned medical volun-
teers, she noted, who were arriving elsewhere in Haiti without infra-
structure or a work team to join; not only were their talents being
wasted, but potentially they could turn into “displaced persons”
themselves who would use up valuable resources that were meant to
help homeless and hungry Haitians.
There were, of course, many dedicated and effective medical per-
sonnel arriving from all parts of the world who did invaluable relief
work without any association with the Cuban-led contingents. But the
Cubans and their ELAM-educated collaborators distinguished them-
selves by their ability to organize and coordinate their efforts into a
long-term sustainable project. They also were the largest disaster relief
presence in the country, far larger than the 269-person foreign contin-
gent fielded by the well-funded and well-respected group Doctors
Without Borders (Médecins Sans Frontières).5
Cuba announced that its presence was destined to become even
larger about a month after the earthquake. Vice President Esteban
Lazo of Cuba, after meeting with President Preval of Haiti, promised
that over the long haul his nation would provide at least two thousand
doctors, plus a variety of other nurses and technicians who would first
devote themselves to the rehabilitation of thousands of severely
injured and the prevention of epidemics. Their overall mission, how-
ever, was broader: Cuba would work with the Haitian government on
the arduous long-term task of building a public health and primary
care system that could serve the whole nation.


This effort was aided by Cuba’s membership in the Bolivarian
Alliance for the Peoples of the Americas (known by its acronym,
ALBA; its other members include Bolivia, Nicaragua, Ecuador, and
Venezuela). ALBA voted to concentrate a significant part of material
assistance to the health system, an effort that had already begun before
the quake. Five Comprehensive Diagnosis Clinics had been built with
ALBA funds in different parts of the country, and five more under con-
struction were rushed to completion by Venezuelan-Haitian work
teams soon after the disaster. Venezuela, the nation that was first to
send an aid shipment to Haiti the day after the quake, also canceled
Haiti’s debt of hundreds of millions of dollars.

Secret to Success: Lifetime Dedication

While all this assistance was being organized and delivered, the main-
stream media in the United States avoided reporting on the substan-
tive contribution of Cuba and Venezuela. However, one of the most
effective U.S. providers of medical aid, Partners in Health, knew from
prior firsthand experience about the expertise and value of working
with Cuban medical professionals. Dr. Paul Farmer, the physician and
anthropologist who was a founder of Partners in Health, has an out-
standing reputation for building systems of community health care
among the poor in rural Haiti and Africa. He once explained, in a
2006 interview, why his Partners in Health medical team decided they
needed help from Cuban doctors even after their hospital operation in
rural Haiti was well established. “We’d been here ten years working,”
said Farmer, “real hard work, yeoman’s work, trying to deliver basic
health services to poor people in central Haiti, before we asked our-
selves ‘Well, what have we done to beef up the public sector?’ . . . It’s
easy in a place like Haiti for groups like ours to say ‘We’re doing great.
We’ve built an OR, and we’ve put in a blood bank.’ But you know you
can always do better.”
The solution? They brought in experienced specialists. Haitian
doctors would have been the first choice, according to Farmer, but


Partners in Health could not find any who were interested in leaving
their middle-class city lifestyles to live in the primitive countryside. So
they asked Cuba for help—not for experts who would give a brief sem-
inar on techniques that could promote public health, but for veterans
who would live and work among the Partners in Health personnel.
Two doctors came for the standard two-year commitment that Cuban
health volunteers make when they work with their own Plan Integral
de Salud medical brigades. “We asked for a pediatrician and a sur-
geon, and we got them,” said Farmer. “The surgeon had been prac-
ticing for thirty years, all over the world. He could do anything. Any
kind of emergency surgery, general surgery; he was very broadly expe-
rienced. The pediatrician had been a pediatrician for twenty-seven
years. The presence of these two very mature physicians, with a lot of
public health experience, really served to raise the level of care all
across the hospital and the system.”
The Partners in Health professionals—doctors, nurses, and health
coordinators who were already known for their selfless service and
willingness to live among the poor—knew they needed more on-the-
job training. Cuban physician/tutors came to the rescue. As Farmer
explained, “There’s no substitute for that in medicine . . . for having
experienced people pass on their way of delivering care to others—to
trainees, to those who are younger or less experienced. But the won-
derful and almost magical thing about the two of them—and about
their successors—is their work ethic and their professional ethic.”6

Transmitting Cuban Medical Skills and Ethics
in Adverse Circumstances

What Dr. Paul Farmer and Partners in Health experienced on a small
scale has become one of the central challenges for the Cuban medical
brigades as they work in more than seventy countries around the
globe. Over the course of little more than a decade, through the inter-
play between international medical cooperation and new kinds of
medical education, Cuba has refined its ideas about how to immedi-


ately effect substantial improvements in the host nation, while at the
same time transferring medical skills and ethics to the host population
by allowing young people to work alongside doctors and nurses in
real-life medical situations. In Haiti, which is not only terribly poor
but the victim of a series of natural and political disasters, this has
been especially difficult.
When the first Cuban medical brigade arrived in Haiti after
Hurricane George under Plan Integral de Salud in December of
1998, at least 90 percent of Haitian doctors were practicing in the
cities, even though more than two-thirds of Haitians lived in the
countryside. The Cuban presence had an almost immediate medical
impact: statistics for 2002 showed that the rate of infant mortality,
that is, the number of babies dying at birth, was only half of what it
had been just two years earlier.7 Over the next eleven years, 6,094
Cuban medical personnel offered their assistance to the Haitian
population, with anywhere from 350 to 800 working at any one
time. On their two-year rotations, they gained enough expertise in
communicating in Creole to spread throughout the country, espe-
cially to rural areas and smaller towns, making it possible to deliver
local primary care services to about three-quarters of the Haitian
population. Between 1998 and 2007, they conducted almost 15 mil-
lion patient visits that helped produce big changes in the overall
health of the nation: the average Haitian life span increased from
fifty-four to sixty-one years, and the maternity death rate, infant mor-
tality rate, and the number of children dying before the age of five
were all reduced by more than half. Near the end of this period,
Haitian students at ELAM were returning home and beginning to
assume a role in community medicine.8
When the first class of students from all over Latin America grad-
uated from ELAM in 2005, a Haitian student, Dr. Jean Pierre Brizmar,
addressed the commencement audience and spoke about his last year
of internship, 2004–05, when he and other students spent six months
working in the Haitian countryside. It had been a rough year, since
parts of Haiti’s north coast were devastated by hurricane flooding, and
the whole country was shaken by political turmoil. This did not deter


Dr. Brizmar and his colleagues. “We lived with our professors,” he
said, referring to the Cuban doctors who supervised his internship.
“And during that time, we saw 773,000 patients. We donated our own
blood when necessary, and nobody went home unattended.”9
It was remarkable that Brizmar’s professors were still present in
Haiti during the 2004–05 school year, because 2004 was the year the
Bush administration encouraged Haiti’s elite political opposition,
funded through the International Republican Institute and USAID, to
overthrow the government of democratically elected President
Aristide. Since Aristide’s government had been building even closer
ties with Cuba and its medical representatives, it appeared that the
new interim government of Prime Minister Gerard Latortue, in defer-
ence to Washington, would demand the departure of all 525 Cuban
health workers present in the country. But it never did so, because
there was no other medical alternative; the huge majority of Haitian
doctors who huddled around the capital and competed for the busi-
ness of well-off clients were not disposed to live in the countryside.
Burnet Cherisol, director of Child Care Haiti and a former priest,
described the situation after the coup: “In many areas the only care
available is from the Cuban doctors, even though the current Haitian
government doesn’t support them. Few Haitian physicians are willing
to venture out this far, where there’s no electricity, no hotel. For them,
the good life stops down the road.”10
The considerable contribution of nurses and other Cuban medical
professionals cannot be overlooked. They made up 40 percent of the
Cuban medical personnel present in Haiti at the time of the earth-
quake, and in addition to providing medical care they served as
important public health educators. In their spare time before the dis-
aster, they joined Cuban literacy teams that were teaching young
Haitians to read. The main beneficiaries of their instruction, however,
were Haitian nurses. Cuban nurse Maritza Acosta explained to Radio
Guantánamo that one important result of this training, particularly in
light of the foreign aid that arrived after the quake, was that they famil-
iarized many Haitians with the uses of modern medical technology:
“We developed a program in the Diagnostic Centers with the Haitian


nursing personnel, who despite being licensed and qualified, had not
mastered technical elements or the modern equipment that had never
arrived in the country before.”11
The Cubans have had so much experience dealing with societies
with little or no medical resources available that their own disaster
relief teams come prepared for everything when they arrive on the
scene. The Henry Reeve Brigade surgeons had modern operating the-
aters set up in tents that were functioning within forty-eight hours of
their arrival in Haiti. This was because they brought their own “elec-
tromedicos,” five-man teams of electricians who know exactly how to
set up the tents in concert with sophisticated equipment powered by
portable generators.
Because the Haitian disaster killed hundreds of thousands and
shattered an entire society, it was also necessary to think about what
would happen after emergency care was provided. In preparation for
a process of recovery that would take many months and years, teams
of Cuban clinical psychologists arrived to help residents work their
way back from the trauma. Accompanying the psychologists was a
troupe of fifty artists, musicians, dancers, puppeteers, acrobats, and
clowns called the Maria Machada Brigade, who lifted spirits and pro-
vided companionship and activities for over 100,000 Haitian children
and teenagers.

“First There Is God and Then the Cuban Doctors”

Observers who were familiar with Cuba’s role in Haiti knew that sus-
tained and expert aid was the key to helping Haitians create a new and
viable health system. Dr. Henriette Chamouillet, who was in charge of
the World Health Organization operations in Haiti after the earth-
quake, said that Cuban help in medical education was “absolutely”
necessary. In the previous ten years, the Latin American School of
Medicine in Havana had been educating as many doctors as Haiti’s
own national medical school, with the difference being that the
Cuban-trained physicians were prepared by their educational experi-


ence to work with the poor. Dr. Chamouillet pointed out that “Cuba
is training Haitian doctors, roughly 80 doctors per year. And that is for
years and years and years already. Three groups of doctors, trained
doctors, are already out of the university and practicing in Haiti. Most
of them return to Haiti. Cuba is only keeping a few of them to train
them as specialists.”12
Dr. Patrick Dely, a Haitian who had been educated at ELAM, told
reporter Conner Gorry that in the past he had seen other Haitian doc-
tors take jobs at public hospitals that paid them very poorly. Soon they
began to shift to treating patients who could pay them privately, and
eventually they were only doing their hospital work one or two days a
week. He thought that the same could have happened to him, except
that he had been transformed during his stay in Cuba: “Like all young
people, I went with my own ideas and philosophy. I had my goals and
my life perspective already in place. I went to Cuba to become a
doctor, to return to serve my people, of course, but also to reach a
level, attain a certain lifestyle, that was beyond my previous possibili-
ties. You know the prestige doctors enjoy in Haiti. But I hadn’t been
in Cuba even two years when my thinking began to change, and my
goals with it.”
Dr. Dely began to realize that he was already very privileged, since
he had been permitted to get a good education in an honorable career,
and that he didn’t need any more privileges. “A new philosophy
began taking shape in my mind. I began dreaming big, beyond just
being a doctor for me. I started thinking about my country, and
thinking about others. I started to feel a responsibility to help as many
people as possible.”13
Although the commitment of Haitians like Dr. Dely is admirable,
Haiti desperately needs large-scale participation by other countries in
support of the Cuban projects, so that more local health care profes-
sionals can earn adequate salaries and work in facilities equipped to
treat the poor. Fortunately, the other members of ALBA, including
Venezuela, had already pledged to back up the Cuban effort with their
own resources. And on March 27, 2010, Haiti, Cuba, and Brazil made
an important announcement about their cooperative venture that


aimed to build a completely new health system. José Gomes, Brazil’s
Minister of Health, said his country would support the effort with $80
million plus the participation of Brazilian educators and medical per-
sonnel who would work alongside their Cuban counterparts. “Haiti
needs a permanent, quality health care system,” he said, “supported
by well-trained professionals. . . . We will provide this, together with
Cuba—a country with an extremely long internationalist experience, a
great degree of technical ability, great determination, and an enormous
amount of heart.”
President René Preval of Haiti, who was present at the same
meeting, pointed out that this project was possible because over the
years the Cuban medical missions to Haiti had gained an incredible
degree of trust from the local people: “For the Haitians first there is
God and then the Cuban doctors. And it’s not just me saying that, one
who is convinced, but also poor people in the communities, the very
poorest citizens.”14
One of the ways to appreciate the special magnitude of the
Cubans’ role in Haiti is to compare it with the medical effort of the
U.S. government immediately after the earthquake. The United States
Navy was lauded, deservedly, by the U.S. media for sending the USNS
Comfort, a hospital ship with a 550-person medical staff, and treating
871 patients and performing 843 surgical operations. But then after
seven weeks, like many foreign aid providers, the ship left Haiti.
During the same period of time, the Cuban medical brigades did
incomparable work, attending to 227,443 patients and performing
6,499 surgeries. But that was only a small extent of their contribution
because they were staying on and expanding their efforts.
By April, three months after the disaster, the Cuba/ALBA initia-
tives had managed to get twenty-three primary care health centers, fif-
teen referral hospitals, and twenty-one rehabilitation facilities “up and
running” according to Cuban foreign minister Bruno Rodriguez. And
this was only the beginning. At the United Nations conference on
Haitian recovery, Rodriguez said that Cuba was committed “to deliver
wide health coverage for the population” and listed the facilities that
would be created: 101 primary health care centers, thirty community


referral hospitals, thirty rehabilitation facilities, a “Haitian National
Specialties Hospital,” directed by eighty Cuban specialists, and new
training facilities for more Haitian doctors.15
Clearly one of the best features of Cuban medical internationalism
is that it keeps growing because it inspires others to join in. Bolivia
benefited immensely from the aid provided by Cuban doctors
between 2006 and 2010, and from significant investment in education
and social welfare through its association with the ALBA nations. It
was not surprising, then, that the La Paz newspaper La Razon proudly
announced on February 28, 2010, that the largest foreign contingent
of ELAM graduates joining the Henry Reeve Brigade in Haiti was
made up of fifty young doctors from Bolivia, twenty-one women and
twenty-nine men. Although almost all of these Cuban-educated doc-
tors enjoyed medical positions and good salaries in Bolivia, they
decided to leave their jobs immediately and stay for an indefinite time
in Haiti; according to the paper, they would stay as long as their assis-
tance was needed by the Haitian people. A few weeks later Dr. Lucio
Pinto told reporters that he left his job in the Bolivian countryside
even though he was not certain it could be held for him. “This is how
to make a reality of Fidel Castro’s dream when he created ELAM,” he
said, “going to work in the countries where doctors don’t exist.”

3. Creating Two, Three . . . One Hundred
Thousand Che Guevaras
The life of Che is a great inspiration for every person who loves liberty.
—NELSON MANDELA , 1991

Before Che Guevara left for Bolivia in 1966, he wrote a letter to the
nonaligned third world countries of Asia, Africa, and Latin America,
encouraging them to unite in their efforts to escape from the historic
domination of the colonialist and imperialist forces of Europe and
North America. He recommended starting many revolutionary strug-
gles and so much simultaneous resistance that the United States and
its allies could not possibly subdue the forces of liberation. The letter
was published the following year and the words of its title, “Create
two, three . . . many Vietnams,”1 were soon repeated around the world.
For the most part, the strategy Che recommended did not work.
With the exception of Vietnam itself, and a few other nations that
achieved liberation from their European masters, the third world lib-
eration movements of the 1960s were stymied by brutal right-wing
strategies or brought down by their own internal conflicts and corrup-
tion. Movements for progressive change throughout Latin America
were overwhelmed by fascist military regimes that were either sup-


ported or tacitly tolerated by Washington. In the 1980s, the Reagan
administration labeled Cuba a “terrorist nation” for inspiring and sup-
porting the legitimate efforts of people fighting for freedom in Central
America and Africa while the United States overtly or covertly sup-
ported an array of dictatorships, counterrevolutionary bandits, and
racist regimes that wanted to destroy these liberation movements.
There was, however, another strategy still available for building
international solidarity and demonstrating that “another world is pos-
sible.” Between 1961 and 2008, Cuba sent 185,000 medical special-
ists to work in 103 nations.2 To amplify this effort and encourage the
participation of other countries, Cuba began providing a free educa-
tion near the end of the 1990s for about 1,500 foreign students per
year at the Latin American School of Medicine in Havana. But this
would provide only a tiny fraction of the doctors the world needed.
Fidel Castro, speaking at the first graduation of doctors from
ELAM in 2005, announced the solution: Cuba and Venezuela were
going to join forces to educate 100,000 more doctors over the next ten
years: 30,000 Venezuelans, 60,000 coming from other countries in
Latin America and the Caribbean, and another 10,000 from nations in
Africa and Asia. Cuba and Venezuela were committing themselves to
creating a new kind of internationalist fighting force, made up of
brigades battling disease and misery.

Reverberations from Bolivia

One noontime in January 2008, I was walking from our house in
Monte Carmelo and passing the local Barrio Adentro clinic where nine
or ten MIC medical students, dressed in their white jackets, were con-
gregating outside. They called me over to meet their new colleagues,
Karen from Peru and Georgo from Suriname, who were beginning the
first-year MIC course. These two were part of a contingent of foreign
students who had been selected for an experimental training program
by the Latin American School of Medicine in Havana (ELAM). Rather
than go to ELAM’s campus in Cuba, they had come to Venezuela to

C R E A T I N G O N E H U N D R E D T H O U S A N D C H E G U E VA R A S 43

join students of Medicina Integral Comunitaria at various locations
around the country. According to Karen and Georgo, there were 335
foreign students in the new program, and “the really big contingent, at
least half of our group, comes from Bolivia.”
Bolivia? The right-wing generals thought they had knocked off
Che Guevara for good in Bolivia. They assassinated him, chopped off
his hands, and sent the fingerprints to Washington. They even hid his
bones in an unmarked grave, where they sat undisturbed for thirty
years. They thought they could kill the spirit of revolution, that there
would be no more Vietnams and no more revolutionaries like Che.
Their efforts were for naught. Now there are Bolivian Dr.
Guevaras, lots of them among hundreds of thousands of young ideal-
istic people who want to follow in his footsteps, dedicated to serving
humanity with a strong sense of revolutionary commitment. They
were jumping at the opportunity to do exactly what the young Che
wanted to do: serve the poor, heal the afflicted, make a better world.
Perhaps the CIA, which had a direct role in helping the Bolivian
army capture and assassinate Che in 1967, was alarmed by this new
threat forty years later. The very same week in January 2008 that for-
eign medical students, including Bolivians, started classes with Cuban
doctors in Venezuela, the CIA presented an intelligence report to the
U.S. Senate that claimed Cuba and Venezuela were having a negative
effect on the governments of Bolivia, Ecuador, and Nicaragua. The
Chancellor of Bolivia quickly rejected the accusations of the CIA: “I
don’t know where they are coming from and where they get their
information. The people of Bolivia know what relations are like with
Cuba and Venezuela.”
What negative effect was the CIA talking about? At the time there
were 2,200 Cuban health workers—1,553 doctors, plus nurses, para-
medics, lab technicians, and auxiliary personnel—at work all over
Bolivia, and Venezuela was financing the construction of various med-
ical facilities. Over the previous two years, 2006 to 2008, over 300,000
Bolivians had their eyesight restored for free by Cuban doctors
working in a program called Misión Milagro (Miracle Mission), which
is financed by Venezuela and has provided free eye surgery to more


than one and a half million people in Latin America and the Caribbean.
At first, many Bolivians were flown to Cuba for surgery, and then fifteen
clinics were set up in Bolivia itself under the direction of joint
Cuban/Bolivian medical teams. In 2006, the Cuban ophthalmologists
operated on one impoverished, anonymous man in a clinic in Santa
Cruz, and shortly thereafter his son wrote the local newspaper to thank
the doctors for their service to his elderly father. The man was Mario
Teran, the Bolivian army sergeant who had been ordered by his supe-
riors to murder Che Guevara after his capture in 1967.
A month after the CIA delivered its 2008 report about the evil
influence of Cuba and Venezuela, ABC News ran a provocative story
about Peace Corps volunteers and Fulbright scholars working on
projects in Bolivia. The U.S. visitors reported that they had been
appalled by the behavior of representatives from their own embassy
who had approached them and asked them to spy on Cuban doctors
and any other Venezuelans and Cubans who were working on aid
projects.3 For some reason, it had not occurred to the U.S. State
Department that many young Americans, especially those who con-
fronted the depth of poverty in Latin America, might not be sympa-
thetic to the U.S. government’s long-standing antipathy to the Cuban
Revolution and the legacy of Che.
A few years earlier, in 2004, when Knight-Ridder reporter Kevin
Hall visited the site of Guevara’s death in Vallegrande and La Higuera,
he encountered Emily George of North Carolina, who was making a
kind of pilgrimage after finishing her Peace Corps duties in Bolivia.
“Che embodied a lot of what my generation is lacking,” George told
him, “[in] his idealism and concern for social justice in Latin
America.” The degree of admiration among local people was even
higher, according to farmer Manual Cortez, who lived next door to the
schoolhouse in La Higuera where Guevara was murdered. “We say,
‘Che, help us with our work or with this planting,’ and it always goes
well. He suffered almost like Our Father, in flesh and bone.”4
Many people in the surrounding area hang pictures of Che on the
walls of their houses next to images of Jesus and the Virgin Mary
because they believe he brings miracles or good luck. But reporter


Nick Buxton noted in 2007 that the symbolic power of Che had
taken on a powerful new earthly reality near the old hospital building
in Vallegrande where Che’s body (in a remarkably Christ-like pose)
had been photographed by CIA agent Felix Rodriguez in 1967.
Behind the hospital is a large clinic staffed by twenty-six Cuban
health professionals who were providing free health care to the sur-
rounding area. “Carmen, a Cuban nurse,” wrote Buxton, “certainly
felt that Che’s dream was being realized. ‘Just imagine if he saw this.
It shows his death was not in vain.’ Working seven days a week with
hardly a break and far from her family, she said she gets her ‘force
from the Comandante.’ Julio and Norma, who come from Santa
Clara in Cuba, a city that Che’s brigade liberated, added: ‘Che said
you should give yourself to others, that is what we are doing, living
out the legacy of Che.’” 5

Origin of the Cuban International Medical Brigades

Cuban revolutionaries from the very beginning felt an obligation to
show “solidarity with their brothers” and go wherever in the world
fellow human beings were in medical need. After the victory of the rev-
olution in 1959, Cuba lost half of its physicians because 3,000 chose
to leave the country, most of them going to the United States.
Although the exodus of doctors created a severe shortage of medical
personnel, some of those who remained behind were asked to volun-
teer for foreign missions. There were two kinds of medical brigades
designed for distinctly different purposes. One dealt with immediate
emergency response to relieve the suffering of people hit by natural
disasters; medical personnel were expected to stay abroad for a matter
of months. The other kind was meant for long-term collaboration in
developing another nation’s system of primary health care; the doc-
tors and nurses who volunteered usually expected to remain for two
years, at which time they would be relieved by other Cubans.
A photograph from 1960 shows Dr. Oscar Fernandez Mel, head
of the Cuban College of Physicians, shaking hands with Dr. Salvador


Allende, who was a senator in the Chilean government at the time.
Fernandez Mel had left urban Cuba behind in the 1950s to join the
guerrillas in the Sierra Maestra, where he had provided some wel-
come relief to the first overburdened guerrilla/physician in Fidel’s
band, Dr. Guevara. In the photo, Dr. Fernandez Mel and a Cuban
medical team are boarding an airplane bound from Havana to
Valdivia, Chile, a small city that had just been devastated by the most
powerful earthquake that has ever been recorded anywhere in the
world. The first Cuban disaster relief brigade was flying to the aid of
the injured and homeless.
Cuban disaster relief brigades will serve in any country, regardless
of its political or religious orientation, and in some cases have helped
nations with which Cuba had no diplomatic relations. For example,
in 1972 Nicaragua was still under the firm dictatorial grip of the noto-
riously corrupt Somoza family, which not only had mistreated its own
population but had openly allowed the CIA to train Cuban exiles in
their territory for the Bay of Pigs invasion of 1961. Nevertheless,
when an earthquake flattened almost all of the capital city of Managua,
Cuba rushed a disaster relief brigade to the scene.
The other kind of Cuban medical aid, concentrating on long-term
medical assistance, was given to Algeria in 1963. This was a gesture
of Cuban solidarity with the revolutionary government of Prime
Minister Ben Bella immediately after the Algerian National Liberation
Front had concluded its long anticolonial war against the French.
Within a week of their arrival, a group of fifty-eight Cuban medical
professionals began to fill some of the gaps in health care delivery that
had been created by the rapid departure of French doctors.
One of the Cuban volunteers was Dr. Sara Perelló, who was born
in 1920 and had begun a career in fine art before taking up medical
studies in Havana, where she graduated in 1953. When she was inter-
viewed in 2004 by journalist Hedelberto Lopez Blanch, Dr. Perelló
was pleased to point out that 1953 was the same year Che Guevara
received his medical degree in Buenos Aires. In 1963, when she was
employed as a specialist in pediatric medicine at a Havana hospital,
she and her mother were listening to a radio program about Ben Bella


of Algeria and his revolutionary solidarity with Cuba. Her mother
turned to her and said, “Hay que ayudar a este muchacho” (We ought
to help this boy).” Because Dr. Perelló’s husband encouraged her and
reassured her that her aging mother would be well cared for, she
immediately volunteered to join the medical brigade that was leaving
for Algeria.
Forty years later, Dr. Perelló could still recount many details about
delivering medical assistance in Algeria and her friendly relationships
with Algerian families. She reflected upon the impact the mission had
on her and her colleagues: “For us, as doctors, it made us grow as
humans. It let us see the role that doctors really ought to have, since
the majority of us were educated under capitalism, with lessons and
concepts very distant from those proposed by the Revolution.” She
said the Cuban doctors had become more useful in their profession,
for it was endowed with a higher purpose. The indefatigable Perelló
never lost that sense of purpose; in 2004, at the age of eighty-four, she
was still teaching a course on “The Mitigation of Disasters” at a med-
ical school in Havana.6

Cuba’s Unprecedented Role in Africa

After Algeria, and throughout five decades, Cuba devoted many mis-
sions of international solidarity to Africa, with more than half a million
Cuban volunteers participating. Cuba’s biggest commitment by far
was in aid to Angola immediately after it won its war of independence
against Portugal. When South Africa began attacking Angola,
Mozambique, and Namibia and backing mercenary armies (with the
assistance of the CIA) in 1975, Cuba insisted on aiding the govern-
ment of the MPLA (People’s Liberation Movement of Angola), even
though the Soviet Union was reluctant to give armed support to
African revolutionary movements. While Washington accused Cuba
of exporting revolution, the Cubans pointed out that they were
defending a liberation movement and revolution that had already suc-
ceeded but was now threatened by extremely reactionary forces, in


particular the apartheid regime in South Africa. Thousands of doc-
tors, nurses, medical technicians, and other civilian experts assisted
Angola’s revolutionary government, but they were not nearly as
numerous as the 300,000 Cuban soldiers who rotated through tours
of duty over the next sixteen years. Cuban troops finally left Angola in
May 1991, right after the peace agreement went into effect that would
assure the end of threats from South Africa. Over a sixteen-year period
in Angola, there were more than 10,000 Cuban casualties, and 2,077
soldiers lost their lives. The Cuban presence not only fortified Angola,
it helped liberate the continent.
Two months after the last Cubans returned home, on July 26,
1991, Nelson Mandela, who had been elected president of South
Africa the previous year, visited Cuba to thank the nation. “The
people of Cuba hold a very special place in the hearts of the African
people,” he said. “In the history of Africa there is no other case of a
people that has risen up in our defense.” In 1995, at the first meeting
of Southern Africans in Solidarity with Cuba, he repeated the mes-
sage: “Cubans came to our region as doctors, teachers, soldiers, agri-
cultural experts, but never as colonizers. They have shared the same
trenches with us in the struggle against colonialism, underdevelop-
ment, and apartheid.”7
Since 1991 Cuba’s international aid to Africa has been strictly
nonmilitary. When South Africa came under the democratic rule of
the African majority, it began asking Cuba for assistance in dealing
with staggering medical problems, such as devising programs to fight
the extraordinarily high rate of HIV infection and helping to alleviate
the shortage of physicians in impoverished rural areas. At times, as
many as four hundred Cuban doctors worked in underserved areas,
even though they were often criticized by South African physicians for
intruding in the country’s medical system. In reality, South Africa had
two medical systems, an expensive European-style, for-profit system
that for the most part served the white population, and a barely func-
tioning public system that was supposed to serve the impoverished
African majority. In the poorest province, the Eastern Cape, where
there is a critical shortage of general practitioners, thirty-two Cuban


specialists joined the faculty of the Walter Sisulu Medical School in
order to help correct the problem. But South Africa, which is as rich
in natural resources as Venezuela, is not politically prepared to redis-
tribute the wealth of the country and generate a massive reallocation of
medical and social resources.
On the other hand, South Africa and other relatively richer African
countries such as Nigeria and Angola did pledge to use modest
amounts of income from natural resources to help some of the most
desperate nations on the continent. At the Group of 77 meeting of
2000, attended by many developing countries, they decided to pro-
vide funds to pay the salaries of 3,000 Cuban doctors who would
serve the poorest countries by developing new infrastructures for pri-
mary health care and education.8 Even though 777 African students
continued to study medicine in Cuba between 2005 and 2009, the
Cubans had already begun to shift the bulk of their attention to the
African continent, where they were developing new medical educa-
tion programs for physicians and other health professionals in Guinea
Bissau, Equatorial Guinea, and Gambia.
These efforts began at the same time that Cuban educators were
reevaluating the medical curriculum used for both their own and for-
eign students within Cuba. Dr. Yiliam Jimenez, a physician and
Cuba’s Vice Minister of Foreign Relations for International
Cooperation, explained the need for changes in training methods to
an international aid conference in 2008: “Traditional models of med-
ical training cannot resolve the terrible lack of health professionals and
the urgent need for access to health care in today’s world.” For this
reason, Cuba had revised its own highly acclaimed medical education
programs to establish new medical schools extra muros, that is, “out-
side the walls” of traditional universities. This was not only happening
in Cuba and on a grand scale in Venezuela, but in smaller new pro-
grams being set up in Bolivia and Africa. “We are returning to the
tutorial method,” said Dr. Jimenez, “supplemented by information
technologies and other teaching aids, so that students from low-
income families can be educated in classrooms and clinics in their own
communities, where their services are so sorely needed.”9


In 2009, I chatted with journalist Hedelberto Lopez Blanch who,
when he is not writing incisive articles for the Cuban press on the
global political economy, is turning out short books about the mis-
sions of Cuban medical professionals abroad, for instance, Historias
Secretas De Medicos Cubanos (Secret Stories of Cuban Doctors),
which recounts testimonies of physicians who went on clandestine
missions with African guerrilla armies in the 1960s and ’70s. Lopez
Blanch had just returned from visiting one of the latest missions of
Cuban doctors in Africa, a brand- new medical school in Zanzibar, the
island in the Indian Ocean that forms part of Tanzania. In 2007,
Cuban medical educators went there to prepare the launch of the first
Programa de Formación de Médicos para la Comunidad (Program of
Medical Education for the Community) in Africa. The Zanzibar med-
ical school was established along the same lines as the six-year pro-
grams that are currently preparing tens of thousands of physicians in
Cuba and Venezuela to practice comprehensive community medicine.
The forty students who made up the first class in 2008 included
twenty men and twenty women, and the latter, in keeping with their
own local communities, wore traditional Muslim dress. All of them
spoke very good Spanish, according to Lopez Blanch, because they
had completed eight months of intensive classes and needed to be able
to converse with their professors. Like the students being prepared by
professor/tutors in other Cuban medical education programs, the
Zanzibar group split their time between working alongside their pro-
fessors at local medical facilities and attending formal classes.10

Cuba and Disaster Relief: Kashmir, Pakistan

In addition to its great commitment to long-term medical assistance
and education programs abroad, Cuba continues to expand the
strength of its highly trained international disaster relief teams. This
buildup gained international attention in the fall of 2005, when over
1,500 medical personnel trained in disaster medicine, the Henry
Reeve Brigade, were gathered at the Havana airport with first-aid


packs on their backs, ready to fly to the U.S. Gulf Coast and aid the
victims of the horrendous flooding caused by Hurricane Katrina.
The Bush administration immediately rejected the offer from
Havana, dismissing the humanitarian gesture as an empty propaganda
ploy. The Cubans would soon demonstrate this was not the case. Only
a month after Hurricane Katrina hit the United States, the Henry
Reeve Brigade, all 1,536 members, was dispatched to the mountains
of Kashmir in Pakistan after an enormous earthquake killed thousands
of people and left hundreds of thousands homeless just as the harsh
winter season was about to begin. Various other international relief
groups also arrived with aid, including European and U.S. teams that
each set up large base camps and stayed for a month. The Cubans
stayed for seven months, building seven major base camps and thirty-
two field hospitals as their medical force was augmented to include
over 2,400 volunteers. The Cubans, who had never seen real winter
before, not only weathered severe temperatures, but had to survive
tents collapsing in the snow when their field hosptitals were snow-
bound for a week after a blizzard. Before they departed, they trained
450 Pakistani doctors in the procedures necessary to operate the
equipment and field hospitals they left behind.
Bruno Rodríguez, who became Cuban Foreign Minister in 2009,
was Deputy Foreign Minister when he arrived in Pakistan in 2005 with
the Henry Reeve Brigade. He spent the next seven months helping
with the relief effort, which eventually led to the two countries estab-
lishing formal diplomatic relations for the first time since 1990. Before
he left Pakistan, it was announced that one thousand Pakistani students
would be given free scholarships to attend medical school in Cuba.

Difficulties Encountered in Promoting Cuban Medical Aid:
Honduras and Guatemala

Honduras and Guatemala were two of the first countries to send stu-
dents to the Latin American School of Medicine in Havana in 1998.
Although several hundred students from these countries were pro-


gressing well in their course work over the next five years, it became
apparent that there would have to be improvements in Cuba’s rela-
tions with their home countries if they were going to effectively serve
their fellow citizens upon their return.
In 2004, during a severe dengue fever epidemic in Tegucigalpa,
the capital of Honduras, more than 400 Honduran medical students
left their studies at the ELAM to join health brigades of Cuban doc-
tors to help control the outbreak. The students treated the sick and
educated the public about prevention measures. Many of them would
be part of the first graduating class at ELAM the following year and
they hoped to get further training in residencies working alongside the
Cubans serving in their country. Unfortunately, 2005 was the year that
conservative president Maduro of Honduras, prodded by the
Honduran Medical Association, announced that the brigade of Cuban
doctors was going to be expelled because their presence was disrup-
tive. The medical association claimed that the Cubans were putting
local doctors out of work, when in reality, as in other countries, few
Honduran doctors were interested in caring for poor people in iso-
lated areas of the country. Right-wing pressure from the likes of
columnist Mary McGrady of the Wall Street Journal stoked an atmos-
phere of antipathy among the Honduran elite and their foreign allies;
McGrady wrote that the doctors were “Fidel’s foot soldiers” who had
“the potential for soft indoctrination, a kind of tilling the soil in the
poor countryside so that it is ready when political opportunity pres-
ents itself, as it has in Venezuela of late.”
Unexpectedly, there was so much protest in favor of the Cuban
presence by ordinary members of civil society, labor unions, and com-
munity organizations throughout Honduras that the president had to
rescind the order.11 Just a few months later, Maduro was replaced by
a new, moderately liberal president, José Manuel Zelaya Rosales, who
rapidly befriended the Cuban and Venezuelan governments and
pledged considerable support to Honduran medical students coming
home. When ELAM graduates returned to the Garifuna region on the
Honduran Mosquitia Coast in 2005 and 2006, they were slated to get
postgraduate residency training from Cuban specialists and a handful


of Honduran doctors who opted to participate. This enabled some
graduates to serve their own people in new hospital facilities such as
the facility constructed in the isolated town of Ciriboya with help from
progressive labor unions and not-for-profit U.S. sources of medical
equipment. In 2008, the new buildings were dedicated by President
Zelaya in a ceremony attended by the Cuban health representatives
and the engineers who helped design and equip the facility. In a star-
tling change of heart, representatives from the Honduran Medical
Association, which three years earlier was trying to chase the Cuban
doctors out of the country, joined the celebration.12
Unfortunately, this recognition of the value of the Cuban partner-
ship lasted only briefly, until the summer of 2009, when the Honduran
oligarchy and military, with the help of Cuban exiles in Miami, engi-
neered a coup against President Zelaya. In the aftermath, soldiers
harassed medical staff and threatened to close down the Garifuna hos-
pital. The founder of the hospital, Dr. Luther Castillo, who had been
the first Garifuna to graduate from ELAM, had to go into hiding to
escape persecution and was forced to abandon the country. In 2010,
he served as the coordinator of the first large contingent of ELAM
graduates in the Henry Reeve Brigade when they rushed to Haiti to
serve as medical volunteers after the earthquake.
In Guatemala, the Cuban presence also provoked controversy and
considerable opposition from right-wing elements. In the year 2000,
the “Secret Anti-Communist Army” (ESA) sent letters that threatened
the lives of the 459 Cuban doctors and medical personnel working in
the country. The ESA letters, published in the daily newspaper Siglo
XXI, accused the Cubans of being “mercenaries cloaked in the noble
medical profession” who were spreading “totalitarian communist
ideas.” And they warned: “If they do not immediately abandon the
country, the executions will begin.” The Guatemalan government
never reacted to the threat, and the Cubans never budged.
The medical brigades have stayed on for another decade as fresh
Cuban volunteers keep replacing those who finish their tours of duty.
Furthermore, the political climate became more favorable, not just
toward the Cubans but also toward the young people who had been


educated in Cuba. In Guatemala, when President Colom took office in
January of 2008, he immediately dispatched his newly elected vice
president, Dr. Rafael Espada, on an official trip to Cuba to study the
Cuban health system. Dr. Espada, an experienced cardiologist who
once trained and worked in the United States, visited the 900
Guatemalan medical students who were studying at ELAM and
praised the quality of their education.13 By the end of 2008, the sup-
port of President Colom and Dr. Espada was proving advantageous to
many graduates who could now return home to postgraduate training
approved by the Guatemalan medical association. In 2009 and 2010,
these former students were able to complete their residencies by
working alongside Cuban professors in community medicine at rural
Guatemalan clinics, or they could join other Cuban doctors who came
to help train ELAM graduates in the specialties the Guatemalan health
ministry had determined were most necessary. For the first time,
Cuban doctors were invited to work alongside Guatemalan experts in
five hospitals, training new specialists in pediatrics, orthopedics, anes-
thesiology, gynecology/obstetrics, and surgery.

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